文章：

现代系统治疗时代下辅助放疗在切除高风险III期皮肤黑色素瘤治疗中的作用

The Role of Adjuvant Radiotherapy for the Treatment of Resected High-Risk Stage III Cutaneous Melanoma in the Era of Modern Systemic Therapies

原文发布日期：16 December 2023

DOI: 10.3390/cancers15245867

类型: Article

开放获取: 是

英文摘要：

Modern adjuvant systemic therapies (STs) have revolutionized the management of stage III melanoma. Currently, the role of adjuvant radiotherapy (RT) remains unclear. In this single-center retrospective study, patients with clinically detectable stage III melanoma with high-risk features for lymph node basin (LNB) recurrence and whose tumors were fully resected with complete lymphadenectomy (CLD) between 2010 and 2019 were assessed. We determined the cumulative incidence (CIF) of LNB recurrence and any disease recurrence or progression using competing risk analysis. A total of 108 patients were identified; the median age was 59 years (24–92), and 74 (69%) were men. A total of 51 (42%) received adjuvant RT, 22 (20%) received adjuvant ST, and 35 (32%) received no adjuvant therapy. The advent of ST changed clinical practice, with a significant increase in the use of adjuvant ST and a decrease in the use of RT when comparing practice patterns before and after 2015 (p< 0.001). The 3-year CIF of LNB recurrence was similar in patients treated with adjuvant RT (6.3%) and adjuvant ST (9.8%). The 3-year CIF of any disease recurrence or progression was lower in patients receiving adjuvant ST (24%) compared to those receiving adjuvant RT (52%) or no adjuvant therapy (55%,p= 0.06). Three-year overall survival (OS) was not significantly different in patients treated with ST compared to those not treated with any ST (p= 0.118). Despite ST replacing RT as the dominant adjuvant treatment modality, this change in practice has not resulted in increased LNB recurrence for patients at high risk of LNB recurrence following CLD.

摘要翻译： 

现代辅助全身治疗（ST）已彻底改变了III期黑色素瘤的治疗模式。目前辅助放疗（RT）的作用仍不明确。本单中心回顾性研究评估了2010年至2019年间接受完全淋巴结清扫术（CLD）根治性切除、具有临床可检测的III期黑色素瘤且伴有淋巴结区域（LNB）复发高风险特征的患者。我们采用竞争风险分析法确定了LNB复发及任何疾病复发或进展的累积发生率（CIF）。共纳入108例患者，中位年龄59岁（范围24-92），其中男性74例（69%）。51例（42%）接受辅助RT，22例（20%）接受辅助ST，35例（32%）未接受辅助治疗。ST的出现改变了临床实践模式：对比2015年前后的治疗策略，辅助ST使用率显著上升，而RT使用率下降（p<0.001）。接受辅助RT治疗患者的3年LNB复发CIF（6.3%）与辅助ST治疗患者（9.8%）相近。接受辅助ST治疗患者的3年任何疾病复发或进展CIF（24%）低于接受辅助RT（52%）或未接受辅助治疗的患者（55%，p=0.06）。接受ST治疗与未接受任何ST治疗患者的3年总生存期（OS）无显著差异（p=0.118）。尽管ST已取代RT成为主导的辅助治疗方式，但这一实践模式的转变并未导致CLD术后LNB复发高风险患者的LNB复发率增加。

原文链接：

The Role of Adjuvant Radiotherapy for the Treatment of Resected High-Risk Stage III Cutaneous Melanoma in the Era of Modern Systemic Therapies